Article by Dr. Ruby Rose, MD.  

“Sitting is more dangerous than smoking, kills more people than HIV and is more treacherous than parachuting. We are sitting ourselves to death.” - James Levine, MD, PhD.

 If you've ever felt the "runner's high" or a significant boost in your mood during a workout, you've encountered the impact of physical activity on the mind-body connection. 

Exercise doesn't just contribute to your mental well-being; there's ample evidence demonstrating its positive effects on various bodily functions. These include improvements in metabolic and cellular processes, immune system and digestive function, cognitive abilities, and its capacity to reduce inflammation while encouraging autophagy (the self-destruction of damaged cells).

 Sedentary Lifestyle is defined as not participating in at least 30 minutes of moderate intensity activity at least 3 days a week for at least 3 months. A sedentary lifestyle is now considered a risk factor for type 2 diabetes and all-cause mortality. It is no wonder that Dr. James Levine coined: 

“Sitting is the new smoking.” 

What does exercise do for chronic pain?

In a previous Wellness Initiative issue, I mentioned the pathophysiology of pain and the unhelpful neuroplasticity that occurs from repeated signals that cause increased sensitivity and firing of neurons leading to central sensitization. 

Examples of central sensitization syndromes (CSS) include fibromyalgia, migraine, irritable bowel syndrome, myofascial pain syndrome, complex regional pain syndrome (CRPS), phantom-limb pain, and even temporomandibular joint disorders. 

These represent just a subset of the numerous conditions diagnosed after prolonged medical investigations, which often yield minimal to no detectable abnormalities. An expanding body of literature delves into the diverse mechanisms underpinning the emergence of chronic pain. 

See also: Headache and Migraines: Everything You Should Know. 

These mechanisms encompass autonomic nervous system and HPA axis dysfunction, mitochondrial dysfunction, dysbiosis, nutrient deficiencies, and hypersensitivity of mast cells. 

These processes cut across various bodily systems and are frequently challenging to assess, proving unresponsive to standard treatment protocols. Nevertheless, many of these conditions have shown positive responses to mind-body techniques and lifestyle adjustments, with exercise playing a particularly pivotal role. 

When we engage in physical activity, we reduce inflammation, enhance energy levels and blood circulation, and elevate the levels of neurotransmitters like dopamine and serotonin in the brain, among other benefits. Our bodies subsequently initiate self-repair processes, including autophagy. When compared to other medical therapies, the cost-effectiveness and broad-ranging systemic advantages of exercise are unmatched.

What types of exercise is recommended?

Just as there's no flawless diet, there isn't a singular exercise that stands above the rest. In the end, it all boils down to the simple act of getting up and moving. Resistance training combined with endurance training has the greatest impact on maintaining lean muscle mass and bone health. 

NIH - Four Types of Exercise: https://www.nia.nih.gov/health/four-types-exercise-can-improve-your-health-and-physical-ability.

How often do I need to exercise?

American College of Sports Medicine recommends:

1. 30-60 min moderate intensity cardiovascular activity 5 days, minimum 150 min/week
2. 20-60 min vigorous intensity cardiovascular activity 3 days, min 75 min/week
3. Resistance training each muscle group 2-3x/week
4. Flexibility training with 1 min stretch/muscle group 2-3x/week
5. Balance and coordination activities for 20-30 min 2-3x/week

The take home here is to add variety to your activity so that you’re working on your cardiovascular, muscle and bone health while maintaining proper core strength for posture and balance.

Exercise Prescription: Just Get Moving!

1. Make it Obvious: the easier it is to notice the cue, the more likely you will act on it. Create an environment where the good choices are in front of you, (i.e., add healthy food on the counter, put a meditation app on your phone).
2. Make it Attractive: the more you enjoy it or anticipate it, the more you’ll be inclined to do it
3. Make it Easy: convenient, simple habits are more sustainable.
4. Make it Satisfying: enjoyable and pleasurable habits have a higher compliance.

For those with suffering from chronic pain and are nervous for starting an exercise regimen:

1. Make it Personal. Do one form of physical activity for a few minutes each day that is fun and comfortable for you to do.
2. Start Slow. Just a few minutes of physical activity can reduce stress and anxiety and improve overall strength and fitness. Start with low-impact activities like walking, cycling, swimming, yoga, or tai chi. If you are too sore the next day, slow down, pace yourself and make sure you’re breathing throughout your exercise.
3. Make A Plan. Put it on your schedule and carve out a reasonable time you can stick with.
4. Don’t Do It Alone. Making an exercise date with a friend, family or group can help motivate you and make you less inclined to cancel or give up, plus you’ll get the added benefits of social connections.
5. Go Outside. Forest bathing and being in natural surroundings can give you added profound stress-relieving effects.
6. Pair Your Activities With a Task. If you need to be on an hour call, take it on a walk.
7. Find a Good Book or Podcast. If you’re hooked on a book, podcast, or in a schooling program, listen while doing an activity such as gardening, yard work, walking, stationary cycling.
8. Get a Wearable. Using a biofeedback option such as the Whoop wrist band or Oura ring can help give you feedback on your daily activities, heart rate variability, and even sleep quality.

You don’t have to join a gym! 

There are many apps and online resources where you can cross train from home. 

FitOn: https://fitonapp.com/. I love this app because it’s free, offers multiple modalities of exercise including weights, yoga, and even meditation and the trainers are excellent and very safe. You can search by time, type, trainer, or equipment. 

Peloton also has similar options on their app but most are meant to be used with one of their products. They do offer some mat and strength training options. 

Yoga: https://yogawithadriene.com/free-yoga-videos/ TRX Bands: https://www.trxtraining.com/. These are a great full body strength training all in one system with an app that gives your exercises you can follow. It’s a killer workout. 

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Dr. Ruby Rose, MD, is board certified in emergency medicine. She is currently the Medical Director of SignatureCare Emergency Center, Austin, TX. Originally from New York City, Dr. Rose graduated from Vassar College in New York before obtaining her medical degree from Tufts University School of Medicine in Boston, Massachusetts. She completed her emergency medicine residency at University of Massachusetts. Dr. Rose has a passion for alternative care and recently graduated from the University of Arizona Integrative Medicine Fellowship in Tucson, Arizona. After relocating to Texas with her family, Dr. Rose worked in St. David’s Healthcare System where she served in several leadership positions. In her spare time, she enjoys watching her kids play various sports and riding her horse in the Texas Hill Country.